Certain embodiments of the present invention relate to a method of assessing health-related problems in a community. More particularly, certain embodiments relate to a method of providing early detection, classification, and reporting of new or unusual health-related events in a population based on emergency room patient information.
Monitoring for health-related problems in a community has long been a concern of health officials. Patient information is generated throughout a community in a variety of ways. For example, the information may be in paper form and stored in a file folder, or in electronic form and stored on a computer. However collected and stored, any particular patient's information tends to be isolated from other patient information in the community. Techniques of electronically collecting and accessing information from various locations such as hospitals and other health care centers is well established in the art. The concepts of creating electronic patient files and records and updating those files and records electronically are also well established. Everything from recording patient symptoms and diagnoses to patient scheduling and billing may be accomplished using various medical information systems such as electronic medical record (EMR) systems. Patient information from various sources may be converted to a common format that may be accessed by multiple users at the same time.
For example, ibex Healthdata Systems markets a product called ibex PulseCheck® which is a web-based emergency department information system comprising various modules for doctors, nurses, and administrators. The system interfaces seamlessly with existing systems. Pulsecheck® is able to create a complete Electronic Medical Record (EMR) for a patient from triage to disposition.
Also, U.S. Pat. No. 5,924,074 to Evans is directed to a medical records system that creates and maintains all patient data electronically. The system captures patient complaints, lab orders, medications, diagnoses, and procedures at its source at the time of entry using a graphical user interface. U.S. Pat. No. 6,088,695 to Kara is directed to bar coding medical data so that it may be transported and stored in both physical and electronic form. U.S. Pat. No. 6,171,237 to Avitall et al. is directed to a remote health monitoring system to provide automated administration of health care to a patient at a remote location and is accomplished electronically. U.S. Pat. No. 5,911,132 to Sloane is directed to a method to collect epidemiological transaction records in a central database computer for the purpose of helping to diagnose new patients with similar symptoms to previous patients.
Even though much patient information for a community may exist in electronic form, it is often not gathered and correlated in a discriminating and timely manner to be of any use for determining health-related events affecting the community, especially new or unusual health-related events that require a quick response by health and/or other government officials. For example, the threat of terrorism has recently become a higher concern to government officials. As a result, certain health-related problems arising in a community, such as food poisoning, water contamination, exposure to nuclear radiation, exposure to poison gas, or exposure to unusual biological agents such as anthrax, may not be detected in a timely manner for health officials and other governmental officials to properly react. Emergency room environments are where symptoms of such health-related problems will first be electronically entered.
Real time surveillance of infectious disease outbreaks is essential for the early detection of epidemics. Current surveillance databases require data entry by individual institutions and submission to a central database for processing. There is currently no data management architecture that allows for active extraction of real time data from a multi-institutional network for the detection of disease outbreaks.
Surveillance, as defined by Alexander Langmiur, “means the continued watchfulness over the distribution and trends of incidence through the systematic collection, consolidation, and evaluation of morbidity and mortality reports and other relevant data” for the purpose of detecting, tracking, monitoring, and preventing adverse health-related events.
The Center of Disease Control (CDC) defines public health surveillance as “the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know”. Collected disease surveillance data are then used by public health professionals, medical professionals, private industry, and interested members of the general public to estimate the magnitude of a health problem, follow trends in its incidence and distribution, detect outbreaks or epidemics, and evaluate control and preventative measures.
There are two general categories of surveillance: passive and active. Passive surveillance is the reporting and confirmation of cases seen in health facilities. In comparison, an active surveillance system is one where case-finding methods are implemented to proactively look for cases. For a successful passive surveillance system, health care providers must be able to correctly identify the clinical manifestations of known diseases with well-defined symptoms and, many times, laboratory confirmation. Passive surveillance has several limitations. In many parts of the rural United States, there is little access to health care facilities, therefore, people who fall ill may not visit a primary care physician and the case goes unreported. There are problems of under-recognition of newly emerging diseases. Laboratory support is often inadequate and/or not standardized. There are often logistical problems in reporting due to unmotivated, untrained, over-worked, and underpaid staff. There is also substantial variation in the quality of surveillance systems from county to county and from state to state.
In 1970, the Surgeon-General of the United States of America declared it, “time to close the book on infectious diseases, declare the war against pestilence won, and shift national resources to such chronic problems as cancer and heart disease”. The indifference displayed by public health experts towards threat of communicable diseases in the 1970's led to less financial and manpower support for communicable disease surveillance systems. Consequently, surveillance systems were not initiated or sustained in the United States. New and re-emerging communicable diseases were allowed to flourish unchecked.
With the emergence of new diseases such as HIV/AIDS, West Nile virus, and Hantavirus, and the resurgence of diseases long since considered under control (such as malaria, cholera, and tuberculosis), domestic surveillance systems have had an abrupt reawakening since it is generally agreed that effective public health surveillance is critical for the early detection and prevention of epidemics. There is a clear and urgent need for surveillance of known and existing communicable diseases, especially those with high epidemic potential. Also, there is a clear and urgent need for early recognition of new infections (over 20 new pathogens have been discovered since the mid-1970's). There is also a need to monitor the growing resistance to anti-microbial drugs.
Although improving, the surveillance capacity of the health care system in the United States is poorly developed. In 1989, all state health departments in the United States began communicating notifiable disease data each week to the CDC through the National Electronic Telecommunication Surveillance System (NETSS). Since then, many state agencies have also initiated computer linkages with their local health departments for disease reporting. However, none have real time analysis or reporting.
Although multiple agencies and individuals in the United States have attempted to address the need for current data from emergency care facilities for the purpose of disease tracking, utilization patterns, and disease surveillance, no system exists that conducts real time, active surveillance of a large number of hospitals in the United States. One main obstacle is the lack of unified data collection parameters and the inability to merge and track incoming data from emergency departments of non-related medical institutions. However, by providing a non-intrusive means to obtain patient health data using a “Sentinel Physician” approach to surveillance, the obstacle may be overcome.
A sentinel physician collects and submits medical data on individual patients during the normal course of a doctor's office visit. The usefulness of sentinel physicians for surveillance has been demonstrated in the United Kingdom, Belgium, and other European countries. In France, a computerized physician based network has been implemented for national public health surveillance.
Each of the aforementioned national and international reporting systems has limitations. For example, each surveillance system was disease specific. Each surveillance system was passive in which standardized reporting forms were distributed en mass to physicians and no action was taken unless completed forms were received by the sponsoring public health agency. Hence, low completion rates resulted. Lag time between disease reporting and notification of public health agencies was greater or equal to a week. Physicians needed training in the surveillance process.
Never before has the need for bio-surveillance capacity been so great. The threat of biological attack, combined with the re-emergence of new and variant infectious agents necessitates the development and use of a functional bio-surveillance system. The public health infrastructure at the county, state, and national level must be primed to instantaneously detect and notify authorities of biological or chemical terrorism. An act of terrorism involving the clandestine release of a biological agent is a major public health emergency and would require an immediate response. In comparison to other emergency events, with the current national surveillance system in place, an attack with a biological agent will not be detected at the time the event occurs, nor will it evoke an immediate response from first responders (police, fire, or emergency medical service personnel). This is because an attack with a biological agent is likely to be clandestine; hence, a delay between exposure and onset of symptoms (an incubation period which may be as long as several days, weeks, or months) may be incurred.
The difficulty of early detection is further confounded because diseases caused by many of the likely bio-terrorist agents may not be accurately diagnosed until late in their course, since early symptoms may seem to be non-specific to a treating physician (e.g., a physician with little or no experience with agents such as smallpox or Ebola). Some possible biological agents include smallpox, anthrax: cutaneous, anthrax: pulmonary, viral hemorrhagic fevers (Ebola, Lassa), brucellosis, tularemia, cutaneous plague, pneumonic plague, botulism, Q fever, typhus, and encephalitis. Some possible chemical agents are ricin, sarin, and organophosphates.
A need exists for an approach to capture specific types of emergency room patient information in real time from throughout a community and process the information to detect, classify, and report health-related alerts for a population in the community in a timely manner. A need also exists to develop a robust algorithm for detecting and classifying a plurality of health-related events in the community with a low probability of false alert and a high probability of correct alert.